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RRAPID Flashcards

1
Q

What are the signs of acute severe asthma ?

A
  • use of accessory muscles

- wheeze

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2
Q

What are the features of acute severe asthma ?

A
  • inability to complete sentences in one breath
  • respiratory rate >25
  • HR > 110
  • PEFR 33-50% of expected
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3
Q

Features of life threatening asthma attack ?

A
  • altered conscious level
  • exhaustion/poor respiratory effort
  • silent chest
  • PEFR
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4
Q

Features of near fatal asthma attack ?

A

Raised PaCO2/ requiring mechanical ventilation with raised pressures

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5
Q

What is the initial response in a severe acute asthma attack ?

A

O SHIT

  • oxygen: 15L non rebreath mask
  • salbutamol - 5mg nebs every 15/20 mins if PEFR
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6
Q

What investigations do you send for in acute severe asthma ?.

A
  • (IV access) bloods- FBC, U&Es, glucose ~CRP, Blood and sputum cultures if sepsis suspected
  • ABG (sats
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7
Q

What are the symptoms of an acute exacerbation of COPD ?

A
  • increasing cough

- reduced exercise tolerance

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8
Q

What are the signs of an acute exacerbation of COPD ?

A
  • use of accessory muscle
  • tachypnoea
  • cyanosis
  • wheeze
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9
Q

What drug treatment would be administered in an acute exacerbation of COPD ?

A
  • Oxygen (controlled, aim for sats 88-92%) - adjust O2 with Venturi mask, but in emergency 15L non rebreath first then titration down when reassess
  • Salbutamol 5mg neb
  • hydrocortisone 200mg IV/prednisolone 40mg PO
  • ipratropium bromide neb

*antibiotics if evidence of infections (empirical- broad spec) e.g. Amoxicillin

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10
Q

What investigation should you request in an acute exacerbation of COPD ?

A
  • bloods- FBC, U&Es, glucose
  • consider blood and sputum cultures if sepsis suspected
  • ABG (decreased PaO2, raised PaCO2 and raised bicarbonate if chronic disease)
  • CXR to exclude pneumothorax/infection
  • ECG (may show cor pulmonale)
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11
Q

If there is no response to nebuliser bronchodilators, oxygen and steroids what should be done next in an acute exacerbation of COPD ?

A

Non invasive, positive pressure ventilation

- if RR > 30, pH

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12
Q

What are the features of a pneumothorax ?

A
  • SOB, sudden onset
  • pleuritic chest pain
  • unilateral reduced chest expansion
  • unilateral deceased breath sounds
  • unilateral hyper resonance to percussion
  • CXR confirmation
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13
Q

What are the features of a tension pneumothorax ?

A

all same signs of pneumothorax (SOB, pleuritic pain, unilateral reduced expansion, decreased breath sounds, hyper resonance) AND:

  • hypotension (must be present to make diagnosis of tension pneumothorax)
  • tracheal deviation (away from affected side)
  • distended neck veins
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14
Q

What is the response to a tension pneumothorax ?

A
  • ABCDE assessment:
  • O2 15L/min via reservoir mask
  • needle decompression - large bore needle in 2nd intercostal space mid clavicular line
  • insertion of chest tube
  • DO NOT DELAY MANAGEMENT TO GET CXR*
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15
Q

What are the risk factors for PE ?

A
  • malignancy
  • post surgery
  • immobility
  • oral contraceptive pill
  • pregnancy
  • previous DVT or PE
  • increasing age
  • infection
  • dehydration
  • obesity
  • smoking
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16
Q

Symptoms of PE?

A
  • sudden SOB
  • pleuritic chest pain
  • haemoptysis
  • syncope
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17
Q

What imaging technique should be used to confirm PE ?

A

CT pulmonary angiogram

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18
Q

What drugs are administered in emergency treatment of massive PE ?

A
  • O2 15/L per min via reservoir mask
  • morphine (5-10mg IV)with antiemetic (if in pain or very distressed)
  • fluid bolus to treat hypotension
  • anticoagulant with LMWH e.g. Tinzaparin, enoxaparin
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19
Q

Signs of PE ?

A
  • hypotension, tachycardia (CV collapse)
  • gallop rhythm
  • raised JVP
  • right ventricular heave
  • pleural rub
  • tachypnoea
  • cyanosis
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20
Q

Investigations for PE ?

A
  • U&Es, FBC, baseline clotting
  • ECG - commonly normal
  • CXR - often normal ~ decreased vascular markings, small pleural effusion, wedge shaped area of infarct
  • ABG: hyperventilation and poor gas exchange -> low PaO2 and low PaCO2, pH often raised
  • D dimer
  • CT pul. Angiogram
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21
Q

What is the definition of status epilepticus ?.

A

Seizures lasting > 30 mins or repeated seizures without regaining consciousness

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22
Q

Features of status epilepticus ?

A
  • tonic clonic seizure
  • non convulsive status is more difficult
  • EEG can help confirm diagnosis
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23
Q

If Someone presents with seizures and they are pregnant what us the likely diagnosis ?.

A

Eclampsia

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24
Q

What investigations should be carried out in status epilepticus ?

A
  • bedside glucose
  • bloods: lab glucose, U&Es, FBC, Ca, Mg, LFTs
  • ABG
  • ECG
  • consider anticonvulsant levels, toxicology screen, LP, Blood culture and urine, carbon monoxide level
  • EEG
  • pulse oximetry, cardiac monitor
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25
What drugs should be administered in status epilepticus ?
- O2 15L/min non rebreath mask - Lorazepam (repeat after 5 mins if fits continue ) - Phenytoin - if fits continue - Diazepam - continued seizures may require anaesthetist sedation
26
What are the symptoms of acute sever asthma ?
- SOB (dyspnoea) - cough (often worse at night) - chest tightness
27
What bloods should you order in an acute MI ?
FBC, U&Es, calcium, magnesium, glucose,troponin
28
Definition of acute kidney injury ?.
- rise in serum creatinine greater than 26umol/L within 48 hrs OR -rise in serum creatinine 1.5 x baseline value within 1 week OR - urine output less than 0.5 ml/kg/hr for 6 consecutive hours
29
Risk factors for AKI ?
- > 75 yrs - CKD - HF - PVD - liver disease - DM - nephrotoxins e.g. NSAIDs, gentamicin, iodinated contrast - hypovolaemia - sepsis
30
Pre renal causes of AKI
- dehydration (vom, diarrhoea, burns, haemorrhage) - hypotension - sepsis - HF
31
Renal causes of AKI ?
- prolonged hypo perfusion - nephrotoxins - glomerulonephritis - vasculitis - interstitial nephritis
32
Post renal causes of AKI
- obstruction e.g. Renal stones, bladder cancer, pelvic mass, enlarged prostate
33
Signs of AKI
- hypovolaemia - assess volume status (cap refill, pulse, bp, JVP, skin turgor, pul oedema, peripheral oedema, urine output) - palpable bladder - signs of vasculitis (weight loss, fever, rash, uveitis, haemoptysis, joint swelling - renal Bruits (renal artery stenosis)
34
Investigations to be done in AKI
- FBC, U&Es, bicarbonate, LFTs, calcium, phosphate - blood cultures if sepsis expected - urine dipstick (presence of blood and protein suggests infection or vasculitis) - CXR - renal tract ultrasound (exclude renal tract obstruction)
35
Response in AKI
- IV access - treat underlying cause (fluids for hypovolaemia, antibiotics for sepsis) - treat complications (hyperkalaemia, pul oedema, acidosis, pericarditis) - REVIEW DRUG CHART (dose adjustments and avoid nephrotoxins) - renal replacement if indicate (e.g. Intractable hyperkalaemia, pH
36
How would you recognise hyperkalaemia ?
- serum potassium >5mmol/L | - ECG changes - tall tented T waves, small P waves, wide QRS
37
Causes of hyperkalaemia ?
- oliguric AKI - potassium sparing diuretics (amiodarone, Spironolactone) - drugs e.g. ACEi - rhabdomyolysis - metabolic acidosis - Addison's disease - massive blood transfusion
38
What are the complications of hyperkalaemia
- cardiac arrhythmias | - sudden death
39
When is immediate treatment required in kyperkalaemia ?
- potassium >6mmol/L with ECG changes OR - potassium > 6.5mmol/L regardless of ECG change
40
Immediate treatment of hyperkalaemia
1. Calcium gluconate - 10%, 10mls over 2 mins (protects the heart) 2. Insulin (short acting) and dextrose - insulin sats potassium into cells temporarily *monitor BM* 3. Salbutamol neb - shifts potassium in to cells temporarily 4. Calcium resonate - removes potassium from GI tract (co prescribe with lactulose) 5. Renal replacement therapy for intractable cases
41
Signs/symptoms of anaphylaxis ?
- rash - urticaria (hives) - laryngeal oedema - angioedema (swelling if deep layers of skin) - severe bronchospasm - hypotension and shock - nausea, vomiting, diarrhoea
42
What type of hypersensitivity reaction is anaphylaxis ?
Type 1, IgE mediated hypersensity
43
Drugs administered in anaphylactic shock ?
- Adrenaline (0.5 mg IM) *repeat as necessary, reassess every 5 mins - chlorphenamine 10mg IV - hydrocortisone 200mg IV - fluid bolus - Hartmanns 500ml stat (10-15 mins) - may need ionotropes/vasopressors to maintain BP - if audible wheeze treat for asthma
44
What simple manoeuvre can be done to help restore circulation in an anaphylactic shock ?
Raise legs
45
What blood tests should be sent for in an anaphylactic shock ?
FBC, U&Es, LFTs, calcium and glucose
46
How would you recognise a broad complex tachycardia ?
- ECG rate greater than 100 bmp - QRS complex > o.12s (3 small squares) - presence of pulse (if no pulse start advanced life support)
47
What bloods should be tested in broad complex tachycardias ?
FBC, U&Es , LFTs, calcium, magnesium, glucose
48
Response in broad complex tachycardia
- give oxygen - IV access - attach cardiac monitor - monitor bp and O2 sats - 12 lead ECG - identify and treat underlying cause (e.g. Electrolyte disturbance esp. Hypo K and Mg)
49
How would you recognise brandy arrhythmias ?.
ECG rate less than 50 Bpm
50
How would you treat bradyarrhythmia with adverse features ?
Add atropine to standard treatment (O2, bloods, monitoring etc)
51
How would you treat a narrow complex tachycardia with adverse features ?
- synchronised DC shock
52
How would you treat a REGULAR narrow comes tachycardia without adverse features ?
- treat as Supraventricular tachycardia - use vagal manoeuvres - adenosine
53
How would you treat an IRREGULAR narrow complex tachycardia ?
- treat as for AF - digoxin or beta blocker for rate control - amiodarone for chemical cardio version and rate control
54
What might be adverse features in a broad or narrow complex tachycardia ?
- shock (systolic
55
How would you treat a broad complex tachycardia with adverse features ?
Synchronised DC shock
56
How would you treat a broad complex tachycardia without adverse features ?
Amiodarone
57
What a the causes of pulmonary oedema ?
- left ventricular failure - fluid overload - neurogenic
58
What are the signs of pulmonary oedema ?
- dyspnoea - orthopnoea - pink frothy sputum - pale, sweaty, distressed - raised JVP - inspiratory crackles - wheeze - triple gallop rhythm
59
What findings would you see on a CXR in pulmonary oedema ?
- cardiomegaly - fluffy bilateral shadowing with peripheral sparing (bat wing) - kerley b lines - pleural effusion
60
Drug treatment in emergency presentation of pulmonary oedema ?
- oxygen - diamorphine (caution in COPD and liver failure) - furosemide - glyceryl tri nitrate - salbutamol nebs if wheeze
61
How would you recognise sepsis ?
Two or more of the following: - temp 38 - HR > 90bmp - tachypnoea >20 - white cell count 12
62
What counts as severe sepsis ?
Sepsis (I.e. Due to infection) + organ disorder
63
What is septic shock ?
Sepsis plus hypotension despite adequate fluid resuscitation
64
What is the response to sepsis ?.
'Sepsis 6' - 6 things to be completed within an hour - use BUFALO: B - blood cultures U - urine output (catheter, monitor hourly) F - fluid - treat hypotension A - antibiotics- broad spec stat L - lactate (and Hb) - measure O - oxygen - 15L/min
65
What is the most common cause of airway obstruction in adults ?
Reduced consciousness level
66
What is see saw chest movement a sign of?
Complete airway obstruction

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